For the Consumer

Along with their needed effects, medicines like melphalan can sometimes cause unwanted effects such as blood problems and other side effects. These and others are described below. Also, because of the way these medicines act on the body, there is a chance that they might cause other unwanted effects that may not occur until months or years after the medicine is used. These delayed effects may include certain types of cancer, such as leukemia. Discuss these possible effects with your doctor.

Along with its needed effects, melphalan may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking melphalan:

Less common

Black, tarry stools

blood in urine or stools

cough or hoarseness, accompanied by fever or chills

fast or irregular heart beat

fever or chills

lower back or side pain, accompanied by fever or chills

painful or difficult urination, accompanied by fever or chills

pinpoint red spots on skin

shortness of breath

skin rash or itching (sudden)

troubled breathing

unusual bleeding or bruising

Rare

Diarrhea

difficulty swallowing

joint pain

redness and/or soreness in arm or leg

sores in the mouth and on the lips

swelling of the feet or lower legs

Some side effects of melphalan may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Nausea and vomiting

For Healthcare Professionals

Applies to melphalan: intravenous powder for injection, oral tablet

Hematologic

Hematologic side effects including bone marrow suppression and anemia have been reported. Bone marrow suppression is the most common and the most significant toxicity associated with melphalan in most patients. Hemolytic anemia has also been reported.[Ref]

Bone marrow suppression is usually reversible if melphalan is withdrawn early enough.[Ref]

Oncologic

The risk of leukemogenesis increases with chronicity of treatment and with cumulative dose.[Ref]

Oncologic side effects including secondary malignancies such as acute nonlymphocytic leukemia, myeloproliferative syndrome, and carcinoma have been reported. Melphalan has been reported to cause chromatid or chromosome damage in humans.[Ref]

Genitourinary

Genitourinary side effects including the suppression of ovarian function in premenopausal women and both reversible and irreversible testicular suppression have been reported.[Ref]

The suppression of ovarian function in premenopausal women has been reported to result in amenorrhea in a significant number of patients.[Ref]

Respiratory

Fatal outcomes associated with pulmonary fibrosis have been reported.[Ref]

Respiratory side effects including pulmonary fibrosis and interstitial pneumonitis have been reported.[Ref]

Dermatologic

Dermatologic side effects including , maculopapular rashes, skin rashes, alopecia, and skin hypersensitivity have been reported.[Ref]

Cardiovascular

Cardiovascular side effects including cardiac arrest and vasculitis have been reported.[Ref]

Gastrointestinal

Gastrointestinal side effects including nausea and vomiting, diarrhea, and oral ulceration have been reported infrequently.[Ref]

Hepatic

Hepatic side effects including toxicity have been reported rarely.[Ref]

Hypersensitivity

Hypersensitivity side effects including anaphylaxis have been reported rarely.[Ref]

Hypersensitivity reactions have been reported after multiple courses of treatment and have recurred in patients who previously experienced a hypersensitivity reaction.[Ref]

Endocrine

Endocrine side effects including two cases of syndrome of inappropriate antidiuretic hormone secretion have been reported following high-dose intravenous melphalan.[Ref]

Other

Other side effects including a sensation of warmth and/or tingling have been reported.

Renal

Renal side effects including temporary significant elevation of the blood urea have been seen in the early stages of therapy in patients with renal damage.

Professional resources

Related treatment guides

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